Letters

Minimising the impact of visual impairment

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7211.707 (Published 11 September 1999) Cite this as: BMJ 1999;319:707

From October this will have to be done to conform to the law

  1. Joyce M Carter, consultant in public health medicine,
  2. Natalie Markham, disability equality officer
  1. Liverpool Health Authority, Liverpool L3 6AL
  2. Liverpool City Council and Liverpool Health Authority, Liverpool L3 2AW
  3. Royal Eye Hospital, Manchester M13 9WH
  4. Directorate of Medicine, Leicester General Hospital NHS Trust, Leicester LE5 4PW

    EDITOR—Margrain's editorial on minimising the impact of visual impairment is firmly based on the medical model of disability, which locates disability in individuals.1 Disabled people have developed the social model as an accurate description of their life experience, and the World Health Organisation is revising its definition of disability to take this into account.2 The social model locates disability in society; therefore it is society that causes “much individual suffering and economic hardship,” not visual impairment.

    The editorial refers to the percentage of visually impaired people who could read normal print before and after the provision of a low vision aid and some training. But if everyone who produced information in print realised that the size of the print (or the use of print) can exclude people from gaining access to the information all information might be fully accessible.

    Under the terms of the Disability Discrimination Act 1995, from October 1999 those who offer goods or services to the public are required to take reasonable steps to ensure that disabled people can make use of their services. A code of practice makes specific reference to the provision of documents in larger or clear print, Moon, or Braille; information on computer diskette; information on audiotape; and telephone services to supplement other information.3

    For the health sector this means, for example, that hospital and primary care information must be available in formats accessible to everyone. The data given in the editorial about the number of people who are visually impaired indicates how many people potentially face discrimination if providers of goods and services do not produce information that is fully accessible.

    The Royal National Institute for the Blind recently reported a survey of health authorities and NHS trusts in Great Britain.4 Of the 326 trusts that responded to a questionnaire, 35% offered general information for patients in large print but only 4% could provide test results in that format. The Royal College of Physicians' charter for disabled people using hospitals states that “every disabled patient, visitor, or hospital employee has the right to relevant and accessible information, especially about the hospital's provision for disabled people.”5

    The principle of ensuring that disabled people are not marginalised can be applied not only to the provision of information but also to other aspects of minimising the impact of an impairment. From October this will no longer be merely about good practice and equity but about conforming to the law.

    Footnotes

    • a Joyce.Carter{at}liverpool-ha.nwest.nhs.uk

    References

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    Training in use of low vision aids is important

    1. Wayne Birchall, senior house officer (moira.pagan{at}virgin.net)
    1. Liverpool Health Authority, Liverpool L3 6AL
    2. Liverpool City Council and Liverpool Health Authority, Liverpool L3 2AW
    3. Royal Eye Hospital, Manchester M13 9WH
    4. Directorate of Medicine, Leicester General Hospital NHS Trust, Leicester LE5 4PW

      EDITOR—Margrain discussed how many people with poor vision are not benefiting from low vision aids, but he underemphasised the importance of training in their use.1 Without training, many aids are likely to be underused and the reading ability in clinics may not be maintained at home.

      Traditionally, hospital clinics for low vision have been run by optometrists on a comparatively infrequent basis. The emphasis has been on dispensing optical aids, including more complex spectacle mounted devices, with comparatively little time being available for training. In a recent postal survey I found that half the clinics in north west England are run solely by visiting optometrists on a monthly basis; in an audit of one such clinic I found that aids costing a third of the annual budget of £11 000 had never been used and that the proportion of patients who were able to read newsprint rose from 16% to only 23%. Humphrey and Thompson showed that only 23% of patients had found their aids useful at home,2 and McIlwaine et al reported that 33% had never used the aids provided.3

      In contrast, detailed analysis of a more integrated approach in Scandinavia found that 80% of patients with macular degeneration related to age were still able to read newsprint five years after being trained by a special teacher over several hours in how to use low vision aids.4 Less intensive training provided by orthoptists in Torbay (an average of 84 minutes per patient) produced good functional results and significantly greater patient satisfaction than in the study of McIlwaine et al.5 This training seemed to be cost effective because of its emphasis on simpler and cheaper aids which offset staffing costs.

      Further study is warranted to establish the best form of integrated, cost effective low vision service and how it might replace the comparatively ineffective and wasteful service still provided in many hospitals.

      References

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      Many visual aids to help people with diabetes are no longer available

      1. A C Burden, consultant physician,
      2. Mary L Burden, diabetes specialist nurse, research and development,
      3. Leanne Hayward, medical student
      1. Liverpool Health Authority, Liverpool L3 6AL
      2. Liverpool City Council and Liverpool Health Authority, Liverpool L3 2AW
      3. Royal Eye Hospital, Manchester M13 9WH
      4. Directorate of Medicine, Leicester General Hospital NHS Trust, Leicester LE5 4PW

        EDITOR—One thing that Margrain does not discuss in his editorial on minimising the impact of visual impairment1 is the difficulty that people with diabetes and visual impairment experience when their diabetes requires insulin treatment or home glucose monitoring. There has been a gradual loss of visual aids to help people with diabetes to inject or monitor themselves. In the past various devices were available: speaking meters, fixed dose syringes, click count syringes, syringe carriers, magnifying lenses, and dose guide cards, as well as cartridge filled pens and prefilled pens. Many of these are no longer available, and we fear that recent government proposals on insulin pens and pen needles may limit prefilled pens as well.

        Diabetes is often associated with visual impairment. By increasing visual aids rather than decreasing them, specific effort should be made to encourage diabetic people to look after themselves.

        References

        1. 1.
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